Sajida, a low-income resident of Lahore, is expecting her fifth child and is severely underweight. Her work entails long, gruelling hours of washing and ironing clothes for 6 different homes. Every time her doctor sees her, Sajida is greeted with gasps of horror as her pale cheeks and weakened body reveal her rapidly deteriorating health. Her haemoglobin count is worryingly low and she needs intravenous vitamin injections to help replenish her energies every few weeks.

Even at a time like this, Sajida cannot afford to worry about what she eats and how that impacts her body. After all, there are plenty of mouths to feed and very little food to consume before she can start to worry about the new life that she is preparing to bring into this world.

Her earlier kids are malnourished: they are more prone to disease, suffer from diminished cognitive development, and are noticeably stunted -- as is 45 per cent of Pakistan’s population. Sadly, her newest baby consistently shows signs of having a low birth weight, a problem facing one in five children born in Pakistan.

Globally, 3.1 million children under the age of 5 die every year due to chronic malnutrition. In Pakistan, female and child health has always been a severely vulnerable subject. The incidence of malnutrition is even higher in rural areas where stunting, wasting, and maternal mortality rates are much higher, while literacy rates are evidently lower.

Pakistan has one of the highest infant mortality rates in the region measured at 66 per 1000 births (World Bank 2015). In contrast, India stands at 38, Bangladesh 31 and Sri Lanka at 8 deaths per 1000 live births. Similarly, the annual number of female deaths per 100,000 live births (maternal mortality ratio) is 178.

The incidence of malnutrition eventually leads to a population which is at high risk of being physically and mentally impaired. The Global Burden of Disease Study reveals that child and maternal malnutrition is one of the leading disease risks linked to diet, and, that "poor diets are bigger disease risk than unsafe sex, alcohol and drug and tobacco combined". The same study, which assesses health related SDG indicators in 188 countries, placed Pakistan 149^th among them.

Much has been said about malnutrition in the past few weeks following recently curated global nutrition statistics. The Global Nutrition Report 2016 reveals Pakistan has the fourth most stunted population in the world, and goes on to link malnutrition to food supply and access to piped water and sanitation. The essential clue that explains high levels of malnutrition, especially as compared to neighbouring countries, is the female secondary enrolment rate in Pakistan. Female education fails to make it to key development agendas, causing an unprecedented blow to basic health metrics.

Malnutrition is linked to several socio-economic and geological factors, such as population growth, income levels, agricultural practices, literacy levels and maternal nourishment. At the heart of the issue is a sheer lack of awareness about one’s own health and nutrition -- a conundrum not limited to the under-privileged class.

However, the glaring scarcity of resources available to the poor, and, the inefficient food distribution system, translates into a larger than life problem -- simply not having enough to eat. The Food Insecurity Index 2015 placed Pakistan 77th among 109 countries, a country where agriculture contributes 20 per cent to GDP, provides livelihood to more 40 per cent of its population, and, where exports constitute major staple foods (rice, wheat, maize).

The effects of poor nutrition do not seem to mend on their own. In fact, health issues are further compounded by a weak public health infrastructure (low budgetary allocations, lack of health workers, under-resourced hospitals and inefficient health services) that fails to cater to the needs of an ailing population.

The International Food Policy Research Institute (IFPRI) suggests making a serious political choice to end malnutrition, increasing investment for the cause and building institutional capacity to eradicate malnutrition in all its forms. None of the offered solutions are new to policymakers in Pakistan and most are even promulgated by law. Implementation is where we continue to fail our nation, one goal at a time.

With one in three people affected by malnutrition globally, costing 2-3 per cent of global GDP in productivity losses, the issue has also led the UN to launch a Decade of Action on Nutrition earlier this year. Poor nutrition is termed one of the most prominent factors that could hamper the achievement of Sustainable Development Goals (SDGs), the development agenda adopted following the completion of the MDGs period.

There are 17 goals and 69 targets committed under the SDGs and the success of each goal is understood to be linked to the other. This approach is attributed to the time-tested premise that economic growth without human capital development is hardly possible. Countries like Singapore, Korea, and Norway have witnessed rapid development after making hefty investments in their social sectors -- including health, education and security -- an approach which provides the first intimations of sustained growth.

Pakistan has also committed itself to the Scaling up Nutrition (SUN) movement of the UN which aims at engaging member countries to take multi-sectoral and multi-stakeholder action to end malnutrition by 2030. In this respect, Pakistan’s Vision 2025 was also adjusted to prioritise the issue of malnutrition and to effectively pursue SDGs.

However, the country’s past record of being off-track on a majority of the MDGs indicators reflects on the ability of successive governments to enact and implement long term development programmes. The MDGs professed eradication of poverty, improvement in maternal health and achievement of universal primary education; all of which could assist in pursuing SDGs and ending malnutrition in the coming years.

To dampen the repercussions of malnutrition manifested in early childhood, several School-Community Based Nutrition Programmes were introduced in Pakistan in the past decade. These include Voucher programmes aimed at helping low-income families purchase staple foods. Lady Health Worker Programmes were initiated to increase health awareness among women, and Women and Child Health Programmes were meant to reduce maternal and infant mortality, with a special focus on achieving Millennium Development Goals. However, under-resourced public departments failed to deliver results and no independent evaluation of the said programmes was ever made.

The continuing lack of capacity to plan and implement reforms trumps any hope that malnutrition can be eradicated by 2030 -- the cross-continent commitment to the SDGs. Projects with high economic and political value, like the CPEC, may bring in trade opportunities for the country and open up new avenues of growth and employment, but they must not be seen as a panacea for all economic and social ills. With low labour productivity, long run output will be severely hampered and future governments will be hard pressed to account for feeble returns on large scale investments.

With the third highest number of stunted children in the word, loss of productivity is eminent and corrective food security measures must be taken with immediate force to redeem economic and social losses suffered so far.